HomeMy WebLinkAbout1389 . _ . ~ ~etlurrtian ~onrqi~~•~i~a
STATE OF FLORIDA l OZ23d 3,. ~
COUNTY OF S~. LUCIG . . ~ ~
This is my Oecleratfon QO~o~~~~~vith SECTIONg222.17~aFlorida Statutesg ~
day in accardence ard ir y , .
I~ t we e~~ j ~ J n .T 1_ S,n' ~ ~J
r•as• tr n•your name c ear y
became ~ a bona f ide resident of the Stete ~ oF Florida o~ F~ ~/05 19
•and I reside et ~4~+~ S~ ~~+A,~i.~ Sr~~; (~f~
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~ in the Cfty of, ~G~.r St. ~ s.:~~ic ~c.c~ ~ ~t~ ~ 14a~;,~
My mailing address iss ~
f eren rom stree e ress
My former legel residence vas in Lhe City oF ~ A M,~" c A•
S t a t e of • ~
(No further statemanCe. is ~required. i~owever, if you wish, you raay insert an
pertinent facts such_as 8ale of progerty or business or relfnquish~ent of
employment aL ~ormer doeaicile, reaaoval of Fecoily to new domicile, purchas~ o
. home, etc.) . • •
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I FURTHER CERTIFY I vill comply ~rfth eIl rerqufrecnents of e tegal resident
this State. I undereLend there is a enalt for er ur er ur is a Felon
P Y P~ 3 Y; p~ Y Y
and'is punishable by incereCion in the Stete Depar~cnent of C~orrecti,ons.
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PRINT NAME ~ SIGNATURE
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PRINT NAME SIGNATUFtE .
Swarn to and ubscribed-before me thia .day of, , 19~9~,,,.
G D , CUIT COURT ~
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- eput er _
RrCORDING INFORMATION
rbt~ ~,m~~~, stete o~ 1~ 2 2 3 4 3
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t4sy ca~missiori bqpire"s: _ - : . ' ~ ' '90 JAN 30 P 1 :54 ~
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. . . . . ~ :aoo~~75 r,,cf1~$9
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